We write in support of the proposed regulations drafted by the Advisory Board of Genetic Counseling, which were unanimously approved by the full Board of Medicine on February 18, 2016.

The National Abortion Federation (NAF) is the professional association of abortion providers. Our mission is to ensure safe, legal, and accessible abortion care, which promotes health and justice for women. Our member facilities care for half of the women who choose abortion in the United States and Canada each year, including Virginia women. NAF is the leading organization offering accredited continuing medical education to health care professionals in all aspects of abortion care. NAF member facilities, including our Virginia members, adhere to our evidence-based Clinical Policy Guidelines (CPGs), which set the standards for quality abortion care in North America. Our experience and expertise includes developing evidence-based standards, drafting medically-appropriate regulations for abortion facilities with state health departments, and assisting health care providers in the delivery of high-quality abortion care.

NAF is committed to patient health and safety, and evidence-based regulations. As such, we support rulemaking for the licensure of medical professionals – including genetic counselors – that is based on the highest standards of professional competence and on the values of care and respect for patients. Likewise, we recognize the importance of empowering patients with knowledge when they make the decision to have an abortion, which is why we have a chapter on “patient education, counseling, and informed consent” in our Clinical Policy Guidelines.

It is also vital that patients be able to rely on their medical professionals to provide unbiased information to help them cope with the difficult decisions that relate to genetic testing. The “refusal clause” in the 2014 legislation to license genetic counselors allows genetic counselors to refuse service to patients based on the counselors’ “deeply held moral or religious beliefs” and shield those same counselors from damages. As a result of this legislation, genetic counselors could deny counseling to any patient for many reasons, including the patient’s willingness to take an action – such as accessing abortion care – with which the counselor does not personally agree.

The denial of such counseling, without protections in place, could risk patient health and diminish their ability to make educated decisions about their healthcare. Delay in accessing abortion care unnecessarily increases the risks to the patient as gestational age increases, and potentially prohibits patients from accessing abortion care entirely.

NAF operates a hotline that is a source of unbiased information about abortion and referrals to providers of quality care. Recently we heard from a woman named Sara B.* who was trying to find sources of funding to access abortion care. She felt anxious about her decision but felt it was right for her situation at the time. She had recently given birth to a son who was born without one of his legs, with his foot attached directly to his pelvis. Her doctor had known that her son would be born without a limb, but did not tell her until the week before her due date. Sara decided to terminate her second pregnancy because of the difficulty of caring for her son and financial issues that resulted from quitting her job, thereby losing her health insurance, to care for him full-time. She also expressed extreme mistrust of the medical community, which made her fear going through another pregnancy, since she felt her doctor had been dishonest with her during her first pregnancy.

Sara’s situation is just one example of why genetic counseling clients should be able to receive the highest level of care from his or her genetic counselor – and should not be subject to substandard, harmful, misleading, inaccurate, or incomplete care based on a genetic counselor’s moral or religious beliefs.

We urge the Board of Medicine to adopt the draft regulations, which have already been unanimously approved by the Advisory Board on Genetic Counseling and the Board of Medicine, certified by the Attorney General, and approved by the Governor. The regulations, particularly 18VAC85-170-150(B), are necessary to ensure the health, safety, and well-being of all Virginia genetic counseling clients.